The following article appeared on pages 14-16 of the February/March 1993
issue of _SIECUS Report_, the publication of the Sex Information and
Education Council of the United States
** ** ** ** ** ** ** ** ** ** ** ** ** ** ** ** ** ** ** ** ** **
TRANSSEXUALITY, IDENTITY, AND EMPOWERMENT
A View from the Front Lines
Barbara E. Warren, Psy.D.
Director of Mental Health and Social Services, Lesbian and Gay
Community Services Center of New York
It is a Thursday night support group. Luis* is talking about adjusting
to being back in school. He is anxious about passing exams and making
new friends. A survivor of foster homes, psychiatric institutions, and
drug addiction, Luis -- at the age of nineteen -- is turning his life
around. He's clean and sober, in a good relationship with his
girlfriend, and getting his GED. The group gives him encouragement and
support to stay in school.
At thirty-six, Karen* is also back in school. In her Wednesday night
support group she shares fears about succeeding in her new career while
juggling school and family responsibilities. Here again, the group
provides support and encouragement for her coping with stress and
hanging on to her aspirations.
In addition to dealing with life transitions and stresses -- the kind
with which anyone might identify -- Luis and Karen share another,
less-common experience. They are transexuals who participate in support
groups at the Gender Identity Project (GIP) of New York City's Lesbian
and Gay Community Services Center. Luis is a female-to-male transexual
man and Karen is a male-to-female transexual woman.
A ROSE BY ANY OTHER NAME
Transexuality and gender dysphoria (discomfort with one's identity as
male or female)) are not modern experiences. Instead they are modern
terms for experiences that have existed and been recorded
cross-culturally throughout history. For example, Native Americans of
the Northern Plains described those with both male and female
characteristics as "the people-in-between" and revered them as
shamans[1]. In Ancient Rome, there was social acceptance for males who
castrated themselves to adopt female identities. Despite its long
history and place in other cultures, transexuality has received a great
deal of publicity in recent years but very little real understanding.
Transexuals are people who find their gender identity (the inner sense
of self as male or female) in conflict with their sexual anatomy.
Transexuality is part of a spectrum of experience related to gender
dysphoria. Manifestations across this spectrum can range from
occasional cross-dressing (wearing clothes that are socially designated
as belonging to the opposite gender); to living part- or full-time in
the gender "opposite" of one's sexual anatomy; to taking hormone therapy
and ultimately undergoing sex reassignment surgery. Transexuality is
differentiated from transvestitism (the Latinate word for
cross-dressing) in that transvestites maintain an inner identity that is
consistent with their sexual identity. For them, cross-dressing is
related to fantasy fulfillment, erotic stimulation, and stress release.
Technically, once sex reassignment surgery has been accomplished, and a
person's sexual anatomy has been surgically corrected to match his or
her gender identity, he or she is no longer transexual. However, many
who have had the transexual experience, male and female, use the term on
a continuing basis as a way to own and to describe their unique
experience. Sometimes the abbreviation "TS" is used as a noun.
Additionally, the dropping of one of the second "_s_" from the
traditional spelling of the word "transsexual" was initiated by some
members of the transexual community to articulate the concept of an
ongoing identity beyond the transition phase. As a member of a
transexual women's support group describes it:
Many of us came into [the support group] with what we have
come to view as a skewed vocabulary. We referred to
non-transexual women as "real." If they were "real", what did
that make us -- "unreal women?" So we tried "biological
women." That didn't work much better. Again, what did it make
us? "Unbiological women?" [And] "Genetic women" left us as
"non-genetic women." We always seemed to be stuck as "non-
somethings" when we wanted to affirm our identity and
experience. So we tried to turn it around. Suppose we, being
us, defined ourselves as us, and defined them as not-us. This
yielded immediate and practical results. They simply became
"non-Transexuals!"[2]
LESBIAN, GAY, BISEXUAL, TRANSEXUAL
Transexuality is often confused with homosexuality. Sexual orientation,
a separate aspect of identity from transexuality, refers to one's
sexual, romantic, and affectional attraction to others. Although gay
men and lesbians may challenge traditional, socially-accepted gender
roles by exhibiting dress and behaviors that are associated with their
"opposite" gender, their gender identities remain congruent with their
sexual anatomy. Contrary to the belief that all true male-to-female
transexual women are sexually attracted to men,[3] approximately fifty
percent of male-to-female transexual women who participate in the
Center's GIP report an affectional, sexual attraction to women. These
transexuals then describe themselves as lesbians. Male-to-female
transexual women who are attracted to men see themselves as heterosexual
in sexual orientation and describe themselves as heterosexual women.
There are also female-to-male transexual men who in their sexual
attraction to men, identify as gay men, as well as female-to-male
transexuals who are attracted to women and identify as heterosexual
men. Sexual orientation then is accurately described in relation to
one's gender identity and not in relation to one's sexual anatomy.
For many transexuals it is part of the evolution of understanding their
transexuality to have attempted to resolve gender dysphoria by trying on
a gay or lesbian identity. For example, many female-to-male transexuals
attracted to women go through a period of identifying as lesbians, but
the inner sense of themselves as men persists. Sandy*, a female-to-male
transexual man, went into a lesbian support group at age fifteen. His
counselors saw Sandy's gender dysphoria as an inability to accept being
lesbian. Unfortunately, his experience in the group was probably
similar to that of any adolescent heterosexual boy put into a group of
homosexual adolescent girls. He could not and did not fit in. This
increased his sense of isolation and despair. After leaving the lesbian
youth program, his drug use escalated. In contrast, four years later,
Sandy's initial experience in the GIP support group for transexual men
was one of intense identification and feelings of relief and hope.
Transexuals who identify as lesbian or gay often face a double stigma.
They may find themselves being rejected by gay and lesbian society as
illegitimate or unauthentic. At the same time they may be reviled by
heterosexual society for being both transexual _and_ gay. One of the
most visible and well known female-to-male transexuals in recent times
was the late Louis Sullivan, journalist and author. As a female-to-male
who identified as a _gay_ transexual man and an activist on behalf of
sexual diversity, he spoke poignantly of his struggle for acceptance as
a gay man:
In my experience of living as a homosexual man, I have found
the gay men's community very accepting and have enjoyed the
companionship of two long-term male lovers. However, along
with the good comes the bad. Ironically, I have been
diagnosed with AIDS, still seen as a gay man's disease. But
somehow it seems like just one more hassle with a body that's
never cooperated with me much anyhow. I took a certain
pleasure in informing the gender clinic that even though their
program told me I could never live as a gay man, it looks like
I'm going to die like one.[4]
COMMUNITY BUILDING
Many gays and lesbians recognize the commonality of experience between
transexuals and homosexuals in the prejudice and exclusion that both
face in the larger society. In this respect the Gender Identity Project
(GIP) fits in with Lesbian and Gay Community Services Center's overall
mission to protect and preserve lesbian and gay rights and culture. The
GIP mirrors the Center's mission in its efforts to enable transexuals to
develop a positive, affirmed identity in an environment of support and
self- acceptance. To this end, the GIP has developed as primarily a
peer-support, peer-driven project that relies on transexuals to help
other transexuals to articulate and to then meet the needs of the
transexual population.
Transexual volunteers, some of whom are human services professionals,
and non-transexual Center staff and volunteers work together to deliver
relevant services. The GIP offers individual short-term peer-counseling
which for many recipients, is the first time they encounter a peer,
someone who not only shares their experience but is also a role model
for the successful resolution of the gender identity crisis.
BARRIERS AND ISSUES
However, even with acceptance and support from the lesbian and gay
community, transexuals still fact many barriers in the society at large
in their quest for dignity and an integrated identity. The prevailing
assumption that the understanding of anatomy is unambiguous -- either
wholly male or wholly female -- is challenged by transexuality and
raises a primal anxiety in most people and in our society. Society's
message serves to produce shame, secrecy, depression, and fear in many
transsexuals. The result of this societal prejudice is increased
isolation and for some, even suicide.
In addition, the reluctance of most physicians and mental health
professionals to treat transsexuals contributes to the sense of
hopelessness many transsexuals feel about ever finding help for gender
identity conflict. To date, medicine lacks valid and reliable,
detectable biological markers for transexuality. Subsequently there are
controversies about proper diagnosis upon which to base treatment
decisions. Many professionals lack training and experience in this area
as it is not a routine part of graduate education. Therefore, many
professionals do not approve or implement irreversible sex reassignment
surgeries. The incredibly high cost of hormone therapy, psychological
evaluation, and sex reassignment surgery -- not to mention the costs of
related cosmetic surgeries, electrolysis, and legal fees -- also serve
to prevent many transexuals from access to the medical, psychological,
and legal resources that do exist. Insurance companies and Medicaid
generally refuse to pay for these services. An ongoing frustration for
the peer counselors at the GIP is the difficulty in securing any
competent and affordable treatment services for many of their
counselees.
The predominant psychological model of transexuality also serves to
further the societal view of transexuals, and subsequently transexuals'
views of themselves, as sick people for whom there is no "cure." Derived
from psychoanalytic and object relations theory, this model views
transexuality as psychopathology related to insufficient identification
with the same gender parent and/or overidentification with the
"opposite" gender parent, during infancy and early childhood.[5] This
model advocates psychotherapy to remediate transexuality by "restoring"
congruency with sexual anatomy. This theory fails to explain: all of
the people with similar childhood experiences who are not and never have
been gender dysphoric; the many transexuals whose childhood experiences
do not fit this model; why gender dysphoria is notoriously impervious to
psychotherapy and therefore has a poor prognosis for change through
psychotherapy.
EMPOWERMENT
Even when transexuals receive professional support to live fully in
their gender identities as men or women, a common experience for many is
the persistence of internalized shame and feelings of unauthenticity
that can haunt their attempts to affirm themselves. The emphasis of the
community-based, peer support model serves to move transexuals,
regardless of their stage of development, away from a shame-based or
pathological self-concept and toward a sense of empowerment within a
unique identity. This necessary support is well illustrated in the
response to the issue of _passing_ written by transexual women who are
members of a self-help support group called Survivors of Transexuality
Anonymous (Passing refers to transexuals being perceived of by others as
"real" men and women.):
... It's not about passing. "Passing" entails attempting to
fool non-transexuals into believing we are something we are
not. Often we want to pass as non-transexuals because of an
unexpressed conviction that only non-transexual women define
femaleness, and, therefore, the best we can do is imitate them
and work for their acceptance. For many of us this meant that
our transexual femaleness, in its own God-given form was
somehow not enough, "less-than" ... [As one of our members
described it] I used to say, "Well sometimes I still sound
like a man. And then it occurred to me. I don't sound like a
man. I sound just exactly and precisely like a transexual
woman... I used to feel embarrassed because I had "man's
hands" or a "man's build." But I don't. I have the hands and
build of a transexual woman. I stopped defining myself in
terms of other people's categories and started defining myself
in terms of me.
Gains and losses in social power based on gender is an issue that
confronts many transexuals. For male-to-female transexual women, it is
adjusting to the loss of social power that occurs when they move from
being perceived of as male to being perceived of as female. It often
comes as a shock to male-to-female transexual women to be sexually
harassed by men, or to find that their earning power as women in the
same occupations they held as "men" has decreased drastically. Giving
up male power, even if it was not particularly valued in the first
place, is often experienced as loss.
Female-to-male transexual men often express feelings of wanting to act,
or more often being expected to act, somewhat macho, to be perceived as
masculine; and to fit in with the guys. For many, these feelings
conflict with sensibilities and sensitivities developed over a lifetime
of being perceived of and socialized as women. Many transexual men
value the qualities associated with being female in our culture and seek
to integrate such qualities into their identities as heterosexual men.
The emphasis that the Gender Identity Project puts on empowerment
counters the conventional advice given to transexuals by many
professionals, and some other transexuals, on the best way to achieve
post-transition adjustment. The traditional approach was to start over
in the "new" identity, and to somehow forget or close off one's former
existence and thereby be reborn. This not only proves impossible for
most transexuals to achieve but undermines attempts to develop an
integrated and affirmative sense of identity. The need to heal from
internalized shame demands coming to terms with one's past, including
the transexual experience, and incorporating it as meaningful and
special. Elaine,* a peer counselor for GIP, expresses her experience
with this process as follows:
I am not a man who became a woman. I was never a man. I was
always a woman. My experience of developing my identity as a
woman differs, of course, from the experiences of non-
transexual women but is just as female and just as valid.
Today, after surgery and with lots of support, I look back on
all of my experiences as being part of who I am including my
transexuality. The problems I faced made me stronger and I am
sensitive to the issues that all of us face, as men, as women,
gay and straight. Because of my transexuality I feel I am a
better person, a more whole person and life, although not
perfect, is pretty good.
There has been an overwhelming response to the Gender Identity Project
in its two years of existence as part of the Lesbian and Gay Community
Services Center, not only in the New York metropolitan area, but via
telephone and written requests for information and assistance from
around the country. This outpouring confirms that there is a tremendous
need for a non-judgemental, educated, affirming and _community-based_
response to the needs of so many people in our society who are
experiencing gender identity conflict.
Barbara Warren is a psychologist, a consultant, and diversity trainer.
She specializes in issues of addiction.
AUTHOR'S NOTES
* Most of the names in this article are fictionalized, as indicated
by an asterisk.
[1] Bolin, A. _In Search of Eve: Transsexual Rites of Passage_. New
York: Bergin & Garvey, 1988.
[2] _Questions Many of Us Ask_. New York: Survivors of Transexuality
Anonymous, 1990.
[3] Benjamin, H. _The Transsexual Phenomenon_. New York: Julian
Press, 1966.
[4] Sullivan, L. "Sullivan's Travels." _The Advocate_, June 1989, pp.
69-71.
[5] Docter, R.F. _Transvestites and Transsexuals: Toward a Theory of
Cross-Gender Behavior_. New York: Plenum Press, 1990.